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        <meta http-equiv="Content-Type" content="text/html; charset=UTF-8">
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    <body>
        <div id="whole">
            <br>
          
            <div id="header">
               
            </div>
            
           
            
            <div id="content">
                
                
                <div id="form">		
			  <form>
			  <fieldset>
                              <legend style="color: green; font-family: monospace; font-weight: 100;">Loan Application Details</legend>
         
                       
			<table border="0" cellpadding="0" cellspacing="0">
            <tr> 
          
    <td style="color: lightslategray; font-size: 12px;">Document Number:</td>
    <td><input type="text" size="20" name="borrowerid" /></td>
  
    <td style="color: lightslategray; font-size: 12px;">Application Number: </td>
    <td><input type="text" size="20" name="fname"/></td>
    
    <td style="color: lightslategray; font-size: 12px;"> Application Date: </td>
     <td><input type="text" size="20" name="mname" /></td>
    </tr>
    <tr>
     <td style="color: lightslategray; font-size: 12px;"> Loan Type: </td>
     <td>
         <select>
             <option></option>
             <option>Loan</option>
             <option>Renew</option>
     </select>
     </td>
    </tr>
    </table>
    
                  
        
        <div class="sad" style="color: lightslategray; font-size: 12px; margin: 20px 0 0 0;" >
            
          Borrower ID Number:<input type="text" size="20" name="borroweridnumber" style="margin-left: 10px;"/><br>
          Borrower Name: <input type="text" size="20" name="firstname" style="margin-left: 33px;"/>
          <input type="text" size="20" name="middlename"/><input type="text" size="20" name="lastname"/><br> 
          Current Address:<input type="text" size="20" name="currentaddress" style="margin-left: 33px;"/>
          <input type="text" size="20" name="barrangay"/><input type="text" size="20" name="city"/>
          <input type="text" size="20" name="province"/><br>
          Area Code:<input type="text" size="20" name="currentaddress" style="margin-left: 63px;"/><br>
          Loan Classification:<input type="text" size="20" name="currentaddress" style="margin-left: 25px;"/><br>
          Loan Term:<input type="text" size="20" name="currentaddress" style="margin-left: 60px;"/><br>
          Amount Applied:<input type="text" size="20" name="currentaddress" style="margin-left: 30px;"/><br>
        </div>
        
                          </fieldset>
	                  </form>
		</div>
                
                <div id="preloan" style="color: lightslategray; font-size: 12px; margin: 20px 0 0 0; width: 300px; float: left;">
                    <fieldset>
           <legend style="color: green; font-family: monospace; font-weight: 100;">Previous Loan</legend>
                    Account No. <input type="text" size="25" style="margin-left: 20px;"/><br>
                    PN Amount <input type="text" size="25" style="margin-left: 23px;"/><br>
                    Loan Class <input type="text" size="25" style="margin-left: 28px;"/><br>
                    Loan Type <input type="text" size="25" style="margin-left: 27px;"/><br>
                    Loan Term <input type="text" size="25" style="margin-left: 28px;"/><br>
                    Loan Balance <input type="text" size="25" style="margin-left: 16px;"/><br>
                    Date of Release <input type="text" size="25" style="margin-left: 5px;"/><br>
                    Loan No. <input type="text" size="25" style="margin-left: 35px;"/><br>
                    Days Left <input type="text" size="25" style="margin-left: 30px;"/><br>
                    </fieldset>
                
                </div>
                
                
                   <div id="preloan" style="color: lightslategray; font-size: 12px; margin: 19px 0 0 0; width: 650px; float: right;">
                    <fieldset>
           <legend style="color: green; font-family: monospace; font-weight: 100;">(To be filled up by Branch Secretary after loan is pre-approved)</legend>
           
                    Coborrower Name <input type="text" size="12"/> <input type="text" size="12"/> <input type="text" size="12"/><br/>
                    Coborrower Address <input type="text" size="12"/> <input type="text" size="12"/> <input type="text" size="12"/><br/>
                    Business Type <input type="text" size="25" style="margin-left: 28px;"/><br/>
                    Amount of Stocks <input type="text" size="25" style="margin-left: 27px;"/>
                    Daily Average <input type="text" size="25" style="margin-left: 28px;"/><br/>
                    Credit Rating <input type="text" size="25" style="margin-left: 16px;"/><br/><br/>
                    Types of Collaterals <br/>
                    <input type="checkbox" name="vehicle" value="Bike" /> Appliances<br />
                    <input type="checkbox" name="vehicle" value="Car" /> Motor Vehicle <br/>
                    <input type="checkbox" name="vehicle" value="Car" /> Passenger Vehicle <br/>
                    <input type="checkbox" name="vehicle" value="Car" /> Passenger Tricycle <br/>
                    <input type="checkbox" name="vehicle" value="Car" /> House and Lot <br/>
                    <input type="checkbox" name="vehicle" value="Car" /> Land Title <br/>

                    Amount Requested <input type="text" size="25" style="margin-left: 30px;"/><br>
                    
                    
                    
                    </fieldset>
                
                </div>
                
            </div>
            
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                <p style="margin: 0 0 0 730px;"> &COPY; Cashmate Credit Corporation 2011 </p>
            
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